Operating on a tiny fetus' heart, or removing a tumor so she can breathe at birth? Yup, doctors are really doing these amazing procedures, and they're saving babies' lives.

A breakthrough that brought hope

In 2011, Jenny and Tawa Torry lost their newborn son, Maddox, to a severe hernia condition at only 19 days old. The next year, they were surprised to find out they were expecting again — but the baby had the same life-threatening condition. A hole in the baby girl’s chest had allowed her abdominal organs to travel upwards, and that would prevent her lungs from developing properly.

What was different this time? One very important thing: The Fetal Center at Texas Children’s Hospital began offering an experimental procedure. They would perform surgery on the Torrys' fetus before she was born.

So, at only 27 weeks into the pregnancy, Jenny and her baby-girl-to-be had surgery. A tiny balloon was inserted into the fetus’s esophagus, stopping amniotic fluid from entering and letting her lungs grow properly. Eight weeks later, baby Milan was born breathing on her own because of the surgery. She needed another procedure to correct the hernia at birth. Today, she’s one year old and walking.

Repairing a “broken” heart

Hernia surgeries aren’t the only in-utero procedures the doctors at Texas Children’s can do. At 20 weeks pregnant, Jennifer Balsamo discovered her fetus had hypoplastic left heart syndrome (HLHS). She was told she could have a potentially life-saving, but risky, heart procedure that would need to be done before her 28th week of pregnancy. Without it, her baby boy may not survive, so Jennifer went through with it. At 37 weeks, baby Aiden was born. He spent three months in intensive care, but eventually was able to go home with his family.

“It’s very difficult to do postnatal cardiac surgery,” explains program Michael A. Belfort, MD, PhD, Obstetrician/Gynocologist-in-Chief at the Texas Children’s Hospital Pavillion for Women. “And the child may still need years of cardiac surgery. Often, with fetal surgery, the child doesn’t have to have additional surgeries.”

More modern-day miracles

The team at Texas Children’s has saved the lives of twins suffering twin-to-twin transfusion syndrome, corrected the spines of babies with spina bifida and removed tumors from babies — all before birth.

“The purpose of fetal surgery is twofold,” explains Belfort. “We’re able to take some conditions that would otherwise be lethal or put the baby at very high risk for injury at birth, and in many cases, mitigate damage. These are conditions that, if you don’t do something, you’re very likely to lose the baby or babies.”

The surgeries come with high risks

Getting one of these surgeries could save baby’s life, but it also comes with a lot of severe potential complications. “The uterus is not a place that’s designed to be interfered with in pregnancy,” says Belfort. “There can be uterine bleeding, rupture of membranes and placental separation. The uterus can contract and it can cause preterm labor. These procedures are not in the mother’s best interest. The mother is risking her own life for the sake of her baby.”

Some of the procedures are done with a tiny needle, inserted into the mother’s belly and then into the fetus. Others are done as open procedures, where mom is given a c-section-style incision, baby gets the surgery and then mom’s belly is closed back up for the remainder of the pregnancy. Probably the most intriguing method is the EXIT (ex utero intrapartum treatment) procedure, where baby’s head and shoulders are actually delivered but the umbilical cord is still attached. Doctors do surgery to make sure baby can breathe on her own before cutting the cord and delivering the baby completely.

But there are big rewards

“I will tell you that it’s an absolute privilege to be able to offer patients these options,” says Belfort. “We have a very close relationship with these patients. We see them often — sometimes for majority of their pregnancies. We have a reunion where we invite all our patients. It’s wonderful to get to see the 1- and 5- and 10-year-olds we’ve done surgery on.”